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The Journal Club
Discussion:
Post irradation complications in NPC post RT patients can range from mucositis to sarcomatous change. The
nasopharyngeal mass may result from chronic skull base osteoitis and erosions often clearly evident on CT scans.
The clinical presentation can mimic a local relapse of NPC. The patient can have repeated epistaxis requiring
various forms of management including embolization. If repeated biopies confirm no recurrence nor malignant
transformation a conservative treatment regimen could be planned. Long term steroid has its side effects and low
dose maintenance dose is used to keep the symptoms of nasal obstrucion and epistaxis to the minimum. Regular
MRI of the NP may be considered to rule out underlying relapse if the tumor is on observation as repeated biopsy
may only be taken from the more superficial layers. The accuracy of MRI NP however needs further evaluation but
it does guide regarding the need for a deeper biopsy if suspicious findings are obvious (2, 3,4,5,6). Pseudotumour
can undergo malignant change and sarcoma is one form which had occurred in one of our patients.
Reference:-
1. Hytiroglou P. et al Inflammatory pseudotumor of the parapharyngeal space. Case report and review of the
literature. HeadNeck 1992 May-Jun:14(3):230-4
2. Nakayama K, Y ,et al Unusual CT and MR findings of inflammatory pseudotumor in the parapharyngeal space:-
case report. AJNR Am J neuroradiol. 2001 Aug:22(7):1394-7
3. .Som PM, B et al Inflammatory pseudotumor of the maxillary sinus:- CT and MR findings in six cases. AJM Am
Jroentegenol. 1994 Sept. 163(3) 689-92
4. Huang DL Inflammatory pseudotumor of nasal cavity. ZhongHua Er Bi Yan Hou Ke Za Zhi 1993:28(4):233-
5,253 Chinese
5. Gong OY et al MRI differentiation of recurrent nasopharyngeal carcinoma from post radiation fibrosis. Comput
Med Imaging Graph. 1991 Nov-Dec: 15(6):423-9
6. Pui MH et al : Imaging of nasopharyngeal carcinoma with Tc-99m MIBI. Clin Nucl Med 1998 Jan: 23(1) 29-32
SENSES 30 July 2010